TEAM RED WHITE & BLUE INC REDACTED.PDF

FOR DLLC USE ONLY
{ , “a ”
Fert datets):
Arizona Depariment cof usenses and Control |
Liquay.
Event time start/end:
Fee= $25. “00 \per'da' for days (consecutive)
0 1-10
A service fee of $25.00 il be che dishonored checks (A.R.S. §44-6852)
!
portion of a location that is not covered by the nto at license, this application must be approved by the
f
local government before submission to the Department f Liquor Licenses and Control (see Section 15).
TEAM RED WHITE: & BLUE INC
SECTION 1 Name of Organization:
2472196347
SECTION 2. Non-Profit/IRS Tax Exempt Number;
SECTION 3 The organization is a: (check one box only)
Ei Charitable (501.C) Fraternal (must have regular membership and have been in existence for over five (5) years)
Oreligious Hicivic (Rotary, College Scholarship) OPoiitical Party, Ballot Measure or Campaign Committee
SECTION 4 Will this event be held on a currently licensed premise and within the already approved premises?
Clyes MNo
Name of Business License Number Phone {include Area Code}
SECTION 5 How is this special event going to conduct all dispensing, serving, and selling of spirituous liquors?
Please read R-19-318 for explanation (look in special event planning guide) and check one of the following boxes.
Cpiace license in non-use
Dbispense and serve all spirituous liquors under retailer’s license
Dispense and serve all spirituous liquors under special event
Ospiit premise between special event and retail location
{If not using retail license, submit a letter of agreement from the agent/owner of the licensed premise to suspend the
license during the event. If the special event is only using a portion of premise, agent/owner will need fo suspend that
portion of the premise.}
SECTION 6 What is the purpose of this event? MlOn-site consumption Ooff-site (auction) LDBoth
McDowell Mountain Regional Park
SECTION 7 Location of the Event:
Address of Location; 16300 McDowell Mountain Park Dr. Fountain Hills Arizona 85255
Street City County/State Zip
SECTION 8 Will this be stacked with a wine festival/cratt distiller festival? Dyes EINo
SECTION 9 Applicant must be a member of the qualifying organization and authorized by an Officer, Director or
Chairperson of the Organization named in Section 1. (Authorizing signature is required in Section 13.)
1. Applicant: Coury Jamil Peter P|
Last First Middle Date of Birth
1731 E. Las Palmaritas Phoenix Arizona 85020
2. Applicant's mailing address;
Street City State Zip
3. Applicant's home/cell phone: Applicant's business phone: { }
4. Applicant's email address: info@aravaiparunning.com
10/17/14 Page 1 of 4
Individuals requiring ADA accommodations call {602}542-9027.

SECTION 10
1. Has the applicant been convicted of a felony, or had a liquor license revoked within the last five (5) years?
OYes MINo (If yes, attach explanation.)
0
2. How many special event licenses have been issued to this location this yeare
(The number cannot exceed 12 events per year; exceptions under A.R.S. §4-203.02(D}.}
3. Is the organization using the services of a promoter or ofher person to manage the event? Dyes MHNo
(if yes, attach a copy of the agreement.)
4. List all people and organizations who will receive the proceeds. Account for 100% of the proceeds. The
organization applying must receive 25% of the gross revenues of the special event liquor sales. Attach an
additional page if necessary.
EAM RED WHITE & BLUE INC 50
Name Percentage
1110 W. Platt Street Tampa Florida 33606
Address
Street City State Zip
Aravaipa Running LLC Percentage 99
Name
1731 E. Las Palmaritas Phoenix Arizona 85020
Address
Sireet City State Zip
5. Please read A.R.S. §4-203.02 Special event license: rules and R19-1-205 Requirements for a Special Event License.
Note: ALL ALCOHOLIC BEVERAGE SALES MUST BE FOR CONSUMPTION AT THE EVENT SITE ONLY.
“NO ALCOHOLIC BEVERAGES SHALL LEAVE SPECIAL EVENT UNLESS THEY ARE IN AUCTION SEALED CONTAINERS
OR THE SPECIAL EVENT LICENSE IS STACKED WITH WINE /CRAFT DISTILLERY FESTIVAL LICENSE”
6. What type of security and control measures will you take to prevent violations of liquor laws at this event?
(List type and number of police/security personnel and type of fencing or contro} baniers, if applicable.)
0 Number of Police 1 Number of Security Personnel MiFencing Dsarriers
ID Check & wrist bands to those over 21 years of age. Security personnel at front of
Explanation;
trailhead area making sure no alcohol leaves the serving area which is the trailhead.
SECTION 11 Date(s} and Hours of Event. May not exceed 10 consecutive days.
See A.R.S. §4-244(15} and (17) for legal hours of service.
Event Start License End
Date Day of Week
Time AM/PM Time AM/PM
05/39/2015 Saturday 4PM 2AM
pay}:
DAY 2:
DAY 3:
DAY 4:
DAY 53:
DAY 6:
DAY 7:
DAY 8:
DAY 9:
DAY 10:
10/17/14 Page 2 of 4
Individuals requiring ADA accommodations call (602)542-9027.

SECTION 12 License premises diagram. The licensed premises for your special event is the area in which you are
authorized to sell, dispense or serve alcoholic beverages under the provisions of your license. The following
is to be used fo prepare a diagram of your special event licensed premises. Please show dimensions,
space
serving areas, fencing, barricades, or other control measures and security position.
Nt
10/17/14 Page 3 of 4
individuals requiring ADA accommodations cail (602)542-9027.

SECTION 13 This section is to be completed only by an Officer, Director or Chairperson of the organization
named in Section 1.
L “TT boyimy ; Cuneta declare that | am an OFFICER, DIRECTOR, or CHAIRPERSON
7 (Print full name)
appointing the applicant listed in Section 9, to apply on behalf of the foregoing organization for a Special Event
Liquor License.
S$ oF
X Oe / - i‘. ) Com, Yee dewalt dvctel Yule | CU
7 (Signature) Title/ Position ate Phone #
The foregoing instrument was acknowledged before me this YN anne ARRAY “2 co | >
, ay ONARY LORETTA’SORRER
State Ak V2 & hLACounty of (“ pre Qs esr a me NOTARY PUBLIC - ARIZONA
OUNTY
ae AY L SESW Peepeitcen canes
Commission on? ') G - xs iS &S SERS ~ aca
My Expires
Date Signature of Notary Public
SECTION 14 This section is to be completed only by the applicant named in Section 97.
Jamil P Coury declare that | am the APPLICANT filing this application as
,
{Print full name}
listed in Section 9. | have read the application and the contents and all statements are true, correct and
complete.
Ont ou President 3/ti/)he -;
x ”
{/ (Signature) d Tile/ Position Date Phone #
The foregoing instrument was acknowledged before me this S ¢ ™M Awe, ) ee) sS
mai WARY LORETTA BURRER |
GEN,
AR Z™6NA or_ ; MAL Ca Gl eee
state county
Mate LREATA eerie ia
119-261 YAO bOs.
My Commission Expires on:
Date Signature of Notary Public
The local governing body may require additional applications to be completed and submitted. Please check with
local government as to how far in advance they require these applications to be submitted. Additional licensing
fees may also be required before approval may be granted. For more information, please contact your local
jurisdiction: http://www.azliquor.gov/assets/documents/homepage docs/spec_event links.pdf.
SECTION 15 Local Governing Body Approval Section
.
recommend DIApprovAL C1] DIsAPPROVAL
L
(government official} {Title}
on behalf of , : ;
(City, Town, County} Signature Date Phone
FOR DEPARTMENT OF LIQUOR LICENSES AND CONTROL USE ONLY
CIAPPROVAL CD DISAPPROVAL _ BY: DATE:
10/17/14 Page 40f 4
Individuals requiring ADA accommodations call {602)542-9027.